Social and economic costs of the obesity inequity gradient
We’ve known for some time that your health and your wealth are connected in an interrelated way. Few would be surprised that less wealthy individuals are more likely to be obese – but the extent of this relationship is disturbing and surprising indeed.
In Australia, there is a higher prevalence of obesity in marginalised populations. This includes Aboriginal and Torres Strait Islander adults; those living outside urban centres; and those living in low socioeconomic status areas, where rates are almost double those in the wealthiest areas. Similarly, in Europe, Women and children in low socioeconomic groups are the most vulnerable to feeling the effects of obesity – and it is passed down the generations. A higher level of education is, unsurprisingly, a protective factor – 26% of obesity in men and 50% of obesity in women can be attributed to inequalities in educational status.
The problem is growing – not only are poor people are more likely to be obese, but the gap is widening, as the prevalence of obesity is rising fastest in lower socioeconomic groups. This gap is a social justice issue, because most of the premature death and illness seen in lower SES groups compared with the richer parts of society can be explained by obesity-associated diseases. Obesity is a large part of what’s keeping the health inequity gaps open.
But it’s not just a social justice issue – it hits the global hip pocket. One study suggested that in England, lost productivity and time off work due to overweight and obesity came to 20 billion pounds per year.The extensive disparities have been recognised as a serious problem by the European regional WHO office, which produced a policy guidance document in 2014 to guide policymaking across Europe in addressing inequities in obesity and overweight and their ‘social and economic consequences’.
The benefits of addressing the obesity inequity gradient are not purely economical, though. Social inequalities in health affect us all, not just the bottom end of the spectrum. There is plenty of measurable evidence for this – For example, a society’s level of inequality is an additional factor in explaining its life expectancy. Across the social spectrum, people live longer in countries with lower levels of inequality. Smaller income gaps are also significantly linked to lower infant mortality and lower incidence of schizophrenia. In Europe, the higher the level of inequality, the more overweight children are. Living in a society rife with inequality undercuts social capital, social cohesion, lowers wellbeing and leads to chronic stress – for everyone.
The injustice is at its most clear regarding children. Obesity in European children is strongly related to the socioeconomic status of their parents – obesity is increasingly about poverty, and it is passed on down the generations. Kids born to an obese mother are twice as likely to be obese later in life, which is related both to epigenetic factors and the fact that your taste preferences are set while you’re a kid. Kids have no control over these factors – and they suffer some pretty serious consequences. Being obese affects a child’s cognitive development, and their ability to learn can be hampered by a high-energy but low-nutrient diet. There’s now a double burden in remote areas of Australia, where Aboriginal children are suffering from malnutrition and adults from obesity – thus putting their kids at risk of developing obesity after a malnourished childhood.
What puts parents in a position where they can’t give their kids the best start in life? Why is this happening?
As discussed in The Conversation’s series Obese Nation, we all make choices about what we eat and how much exercise we do – but these choices are heavily influenced by the context in which we make them. As you drop down the socioeconomic ladder, social, cultural, and economic environmental pressures increase. UK organisation Action for Children found that vegetables and fruit can be 30-40% more expensive in poor neighbourhoods – while there are four times the number of fast food outlets. Compounding this is that the proportion of income required to buy a basket of healthy food is 3 to 4 times more expensive for those on a low income compared to those on a high income. How free are you really to choose what you’d like to eat for dinner?
If we look at remote Australia, the picture becomes even more grim. Food prices in the NT are 45% more than urban centres. 16% of the health gap between Indigenous and non-Indigenous australians is attributable to overweight and obesity – it’s the second highest contributor after smoking. That’s not including the clearly related determinant of physical activity, which accounts for a further 12% of the gap. It’s not hard to see why – rural Australia has limited recreation centres, an oppressive climate, and few safe walking paths. Housing in remote communities is notoriously decrepit, often with poor cooking and storage facilities. If people can’t afford to buy healthy food and don’t have the skills or facilities to cook it, it’ll be hard to close the gap.
The way forward
Thankfully, interventions no longer focus so much on the judgmental, flawed conviction that individual poor self control is the root of obesity inequities. Instead, current policy focuses on the influence of ‘obesogenic’ (obesity causing) environments and how they can be changed at the level of policy. If you live in a disadvantaged neighborhood, there may be nowhere safe to exercise, run around, and play outside – particularly for women and children. So, kids spend longer watching TV. Not only is there an opportunity cost for this sedentary time, but the exposure to fast food advertising increases.Food pricing and economic levers are clearly important – but fat taxes here risk being regressive, because they’ll affect the poor the most – which only exacerbates the problem. The Conversation suggests that subsidies are a better option – let people save money by eating healthy, alleviating both of the interrelated factors of obesity and poverty simultaneously.
We need to develop systematic approaches which help keep us all health, with a special focus on helping those who need it most – not just for the sake of the poor, but of us all.